A Missing Ingredient in Mental Health Recovery

I see many people through their journeys from illness to wellness. A big sign that someone is not doing well and the severity of their symptoms, is when they have taken time off work. I am often consulted when what was initially supposed to be a two-week break, has become one-month, even up to a one-year leave from work. The unexpected lengthy time off is a cause for concern for everyone involved including the family doctor, the patient, the patient's family, and the patient's employer.

When I get involved, many outcomes are possible. It can range from being a simple medication issue, to revisiting and re-evaluating the main diagnosis. On the rare occasion, it may be helping the patient come to terms with medical retirement, that returning to work may not be possible given the severity of illness and how work may exacerbate symptoms. Most of the time however, patients come into my care wanting to return to work and are completely mystified as to why they are not feeling better. They see me in the context of having many productive years in the workforce, and their inability to return causes both frustration and hopelessness.

I have found these patients to be some of the most diligent individuals I have worked with. They come into appointments with a pen and notepad ready to write down any recommendations from our appointment. They have documents prepared detailing for me what has happened in their care so far. They have followed all the recommendations given so far from getting a therapist to attending support groups. I have found many of my patients on medical leave to be hardworking and engaged with care. They attend appointments and take medications reliably as prescribed by their doctors. They take their recovery seriously. So it is confusing that with all of their efforts and dedication, they are not feeling better. What is going on?

What I have found in my discussions with these patients, and what has been a turning point for many, is the realization that they had been focusing so much on the work of their recovery, from filling out forms, taking phone calls and visiting their physicians, that they have forgotten a very vital part of recovery. And that is that at some point, recovery is supposed to be...fun. The necessary ingredients to a full recovery from all mental illnesses are proper rest and relaxation alongside the rediscovering of what delights and inspires.

So an intervention of mine is to actually recommend they stop taking their recovery so seriously. I give them permission to pursue things that make them feel good again. I may even suggest they travel if they can. When this is not stated or recommended in the care plan, patients who are at the mercy of insurance companies and doctors' evaluations often feel they are not allowed to experience joy, that joy while on sick leave not only looks bad but is dishonest. They believe, quite understandably, that joy suggests you are not sick. There is immense fear that if they are found attending a concert, restarting crochet, or taking a cooking class, that they are not sick enough to take leave. I understand these sentiments, but they run counter to what recovery from mental health requires at a certain point. Afterall, illness and recovery are on a continuum. What is recovery, if not the gradual reduction and elimination of suffering with the corresponding gradual return to feeling like yourself and having some zest again?

So when in recovery from a mental illness, here I focus on patients on medical leave from work, but the following prescription/saying applies to everyone: A dose of Joy once a day, keeps the doctor away.